Jesse Mez, MD, from the Boston University School of Medicine, and colleagues present a case from the ongoing Understanding Neurological Injury and Traumatic Encephalopathy (UNITE) Study.

The researchers describe a 25-year-old patient with a congenital bicuspid aortic valve, as well as family history of addiction and depression, who died of cardiac arrest. The patient played American football for 16 years, from age 6. He experienced more than 10 concussions, none of which resulted in hospitalization. Following a concussion during his freshman year of college, he had persistent symptoms and stopped playing football soon afterward. His symptoms persisted and included apathy, decreased appetite, and passive suicidal ideations. In contrast to his earlier demeanor, at age 23 years he became verbally and physically abusive toward his wife. He underwent neuropsychological evaluation at age 24. UNITE members supported postconcussive syndrome as the primary diagnosis, with CTE and depression as contributing diagnoses. Neuropsychological performance did not differentiate postconcussive syndrome or major depression from CTE.

"While the case suggests that CTE should be considered in the differential diagnosis of a young adult with extensive repetitive head impact exposure and persistent mood and behavioral symptoms, it does not allow us to infer the likelihood of CTE in this setting," the authors write.